Prevention & lipidsCohort study
Low levels of atherogenic lipoproteins and incident atherosclerotic cardiovascular disease: A pooled cohort primary prevention study
- pooled cohort primary prevention study
- 3 population-based prospective cohorts
- multivariable Cox proportional hazards
Authors' conclusion
Among adults without ASCVD not taking lipid-lowering therapy at baseline, ASCVD risk for adults with low-normal and high-normal LDL-C, non-HDL-C and apoB was similar, and their risk remained less than in adults with elevated lipoproteins. These findings emphasize the importance of achieving normal atherogenic lipoprotein levels for primary prevention of ASCVD from early adulthood through middle age.
Study context
- Population
- Adults without atherosclerotic cardiovascular disease (ASCVD) and not taking lipid-lowering therapy at baselinepooled from 3 population-based prospective cohorts
- Participants
- 16,384 adults
- Exposure
- ASCVD events by baseline LDL-C, non-HDL-C and apoB, including low-normal values
Main finding
As reported in the abstract
Unadjusted ASCVD event incidence · median follow-up of 18.8 years
- Similar for LDL-C < 70 mg/dL and 70 to 99 mg/dL, and higher with LDL-C ≥ 100 mg/dL; trends similar for non-HDL-C and apoB categories
Observational data: associations, not effects.
Further findings
| Outcome | adjusted HR (95% CI) | |
|---|---|---|
| ASCVD risk (multivariable-adjusted) · median follow-up of 18.8 years — LDL-C < 70 mg/dL vs LDL-C 70 to 99 mg/dL · similar ASCVD risk · after multivariable adjustment | 1.16 (0.90–1.50) | |
| ASCVD risk (multivariable-adjusted) · median follow-up of 18.8 years — LDL-C ≥ 130 mg/dL vs LDL-C 70 to 99 mg/dL · higher risk · after multivariable adjustment | 1.31 (1.14–1.50) | |
| 0.512Adjusted hazard ratio (log scale) |
ASCVD risk (multivariable-adjusted) · median follow-up of 18.8 years
- Adults with non-HDL-C ≥ 160 mg/dL or apoB ≥ 90 mg/dL also had higher risk after multivariable adjustment
Baseline characteristics
- mean age (SD 18) years
- 52
- women
- 56.5%
- White race
- 64.7%
- Black race
- 35.3%
Original publication
Low levels of atherogenic lipoproteins and incident atherosclerotic cardiovascular disease: A pooled cohort primary prevention study. Am Heart J. Published 27 January 2026. doi:10.1016/j.ahj.2026.107354
Summarised from the published abstract; every number is checked against it